Healthcare Provider Details

I. General information

NPI: 1275818965
Provider Name (Legal Business Name): SERENITY HOSPICE HOME, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 KING RICHARD RD
DRY PRONG LA
71423-8705
US

IV. Provider business mailing address

72 KING RICHARD RD
DRY PRONG LA
71423-8705
US

V. Phone/Fax

Practice location:
  • Phone: 318-664-0082
  • Fax:
Mailing address:
  • Phone: 318-664-0082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License Number
License Number State

VIII. Authorized Official

Name: MRS. WINONA SUZANNE SHORT
Title or Position: PRESIDENT/CEO
Credential: RN, MSN
Phone: 318-664-0082